A more or less natural erection can be simulated not only by the im­plantation of an erection prosthesis, but also by the use of a so-called vacuum pump in combination with a penile constriction ring. Down the ages the constriction ring has been used a sex aid. Four hundred years ago in Japan penile rings belonged in so-called love boxes and Bedouins used the dried eyelashes of goats to make them. It was thought that the lashes would provide extra stimulus during inter­course and arouse the woman sexually. Such rings are still available in sex shops.

Vacuum apparatus has been on the market for almost a hundred years. Zabludowsky’s version is described in Manual of the Sexual Sciences (1912) by the German psychiatrist Albert Moll. Until recently vacuum erection apparatus attracted almost no attention in medical circles, but plenty from the owners of sex shops, where it is on sale even today.

The modern vacuum apparatus consists of a cylinder, a pump and constriction band or ring. A true vacuum (with zero air pressure) is for­tunately never achieved, since if it were the pump would be entirely filled with a bleeding penis. Actually a better name would be under­pressure apparatus. The cylinder, closed at one end, is slid over the penis, open end first, and pushed against the pubic bone to form an

Подпись: A Zabludowsky vacuum pump.
The vacuum pump

airtight seal. It is sometimes useful to cut away the pubic hair at the base of the penis. At the closed end the cylinder is connected to the pump, which creates underpressure in the cylinder, so that blood is sucked towards the erectile tissue and an erection is created. The required pressure is 120 millibars, which is the pressure in the erectile tissue compartments in erection. In reality, however, more is needed. When the penis is sufficiently erect, the ring, which was previously placed round the base of the cylinder, is rolled down, so that the outflow of blood from the erectile tissue compartments is impeded. At that moment some blood always leaks away, causing a proportion­ately large loss of pressure. This is why an underpressure of 200 millibars must be built up. Once the constriction ring is in place, blood can no longer leak out of the erectile tissue compartments. The ring has an indentation on its underside to avoid the urethra being squeezed completely shut, impeding ejaculation. The ring must remain in place no longer than 30 minutes and naturally one must not sleep with it on.

Because of the accumulation of blood the penis may turn slightly blue. Sometimes there are small pinpoint haemorrhages, and the penis may feel cold. ‘It was like making love to an iceberg,’ as one woman put it. The base of the penis may also wobble, thus sometimes complicat­ing insertion. It goes without saying that the use of a vacuum appara­tus during intercourse stands or falls with the presence of a sympathetic and understanding woman, who does not make excessive aesthetic demands on the man’s phallus.

Подпись: The vacuum pump with a rubber constric-tion ring at the base.
The vacuum pump

Inspired by the penis bone

The first operation to insert a penis prosthesis took place in 1936. In order to reconstruct a male member amputated in a trauma, the plastic surgeon Bogoras implanted a section of rib cartilage, prompted by his observation of the presence of a penis bone in many male mammals. The human penis is rather an odd man out, since that of numerous other mammals contains such a bone, called a baculum. These include the whale, the dolphin, the walrus, the otter, the bear, the marten, the badger, the squirrel, the wolf, the dog and the monkey. In some species, for example in the spider monkey, there is also a section of bone or cartilage in the clitoris.

In 1951 Bett wrote an extensive article on the penis bone. In the whale the bone is some 2 metres long, with a circumference of 40 cm at the base. Further up the evolutionary ladder it becomes smaller: in the walrus it is only just over 50 cm and in the monkey it measures only between 1 and 2 cm. Up to now there are no indications that homo sapiens ever possessed such a bone. The position and shape of the bone vary from animal to animal. In the dog, for example, it forms a channel for the urethra, while in the bear and the wolf the baculum is indispensable for mating. The baculum may have many different kinds

of shape. In the racoon, for example, it is s-shaped and in the bat it is forked. In the squirrel there is a sharp hook attached, which according to some experts is designed to perforate the hymen. Others believe that the hook is designed to remove so-call mating plugs. A mating plug consists of a sticky residue of sperm allowing the vagina of the female squirrel to be temporarily ‘sealed’ in order to prevent sperm donation by another male. In the otter the penis bone is characterized by extreme hardness, though healed penis fractures have been observed in these creatures. When male otters fight each other, they target their oppo­nent’s penis with their powerful jaws and sharp teeth, and often succeed in breaking the baculum!

The penis bone also occasionally crops up in literature. Henry Miller, the first serious modern writer to give an honest account of his tur­bulent love life, mentions it in Tropic of Cancer, in his colourful style:

0 Tania, where now is that warm cunt of yours, those fat, heavy garters, those soft, bulging thighs? There is a bone in my prick six inches long. I will ream out every wrinkle in your cunt, Tania, big with seed. . . I shoot hot bolts into you, Tania,

1 make your ovaries incandescent. Your Sylvester is a little jeal­ous now? He feels something, does he? He feels the remnants of my big prick. I have set the shores a little wider. I have ironed out the wrinkles. After me you can take on stallions, bulls, rams, drakes, St. Bernards.

This fantasy is not a degradation of women, far from it. It is modern man’s painfully transparent anxiety: sexual envy and fear of having too small a penis.

Подпись: X-ray photo of a dog’s baculum.
The vacuum pump

The use of genuine rib cartilage as a penis prosthesis proved inad­equate in the long term: the material was eventually reabsorbed by the body. For this reason synthetic prostheses were developed in the 1950s. To begin with these were inserted in the penis, but outside the erectile tissue compartments. This had in fact been tried thousands of years previously in China: with chicken bones. The problem was that in time

Подпись: The inflatable erection pros-thesis.
The vacuum pump
The vacuum pump
Подпись: Cylinders

The vacuum pumpthe chicken bone bored through the skin, and initially the same thing happened with the subcutaneously inserted prostheses. For that reason the technique was modified; in i960 Beheri described the operating technique still current today in which two plastic cylinders, which may or may not be inflatable, are placed in the erectile tissue compartments and as it were fill them; this procedure entails the permanent loss of the spongiform erectile tissue.

The implanting of a prosthetic is an irrevocable step, since it in­volves the sacrificing of the penis’s own capacity to swell. Even given optimum information it is often difficult for patients and their partners to imagine in advance what living with a penile prosthesis will be like. Talking to a patient who has already been through a similar procedure – usually a very effective way of briefing patients – is generally not feasible, often due in large part to false modesty on both sides. In this way things remain veiled in secrecy. We find this in the novel The Story of R (1990) by the Italian writer Gaia Servadio, in which her main character, a rich businesswoman, tells her adored young lover the following about a penile prosthesis:

‘I shouldn’t be telling you these things, but the Baron’s just come back from Bulgaria where he had plastic surgery done to his. . . yes, well, eh, you know what I’m talking about! A small internal pump so that with a bit of manipulation, he can get it up. Apparently it’s a painful operation, but many people have it done. I mean, what is one to do? When a man’s reached the age of seventy, he knows everything there is to know about sex, but he can’t do anything about it any more. For women it’s different, eh?’

‘But once the pump’s been inserted, what can a man do?